Oral Cancers
Oral Cancer means cancer of the cavity of the mouth which includes the different areas like the inner lining of the mouth, tongue, gums, lips, the roof of mouth & floor of the mouth.
Best Oral Cancers Surgery in India
What is oral cancer?
Oral Cancer means cancer of the cavity of the mouth which includes the different areas like the inner lining of the mouth, tongue, gums, lips, the roof of mouth & floor of the mouth. It appears as an ulcer, growth, or lump in the mouth which doesn't respond to treatment taken and doesn't heal over time.
Oral cancers are life-threatening and can spread to the whole body if not diagnosed and treated early.
Stages of oral cancer
When oral cancer is diagnosed early, it is much easier for us to treat. But still, most people get a diagnosis when their condition is too advanced for any treatment. Sometimes even when it is diagnosed early, people seek alternative treatments instead of standard protocoled treatment which leads to advancing their disease.
Oral cancer is seen most commonly in people who consume tobacco in any form and overindulge in alcohol.
Who gets oral cancer?
Most people get oral cancer after the age of 50 years. But nowadays younger people in the age group of 25-30 years are also getting oral cancers. The younger the age, the more aggressive the tumor.
Men are at least two times more at risk to get oral cancer in comparison to women
A link between oral cancer and not eating enough vegetables and fruits is established in multiple studies.
It is important to note that over 25% of all oral cancers occur in people who do not smoke and who only drink alcohol occasionally.
What are the Symptoms of Oral Cancer
- Any ulcer or growth in the cavity of the mouth which is painless bleeds on touch, and has not healed over a month despite all medications.
- Any thickening or swelling over velvety white or red patches in the mouth.
- Swelling or pain in the jaws.
- Unusual bleeding from the mouth.
- Problems in wearing dentures.
- Unexpected loosening of teeth.
- Difficulty in chewing or swallowing food, speaking, or moving the jaw or tongue in advanced stages
- Hoarseness or change in voice if cancer has spread down to the voice apparatus
- Unexplained weight loss
What can cause oral cance?
- Tobacco consumption- smoking in form of cigarettes, cigars, and pipes and smokeless tobacco use in form of paan masala, and chewing paan.
- Excessive Alcohol Consumption.
- Certain strains of Human Papillomavirus (HPV) are responsible for oral and oropharyngeal cancers. The incidence of oral cancers is increasing in healthy males under 50 in their mouths and throats from oral— The chance of developing oral cancer increases if someone is exposed to multiple sexual partners.
- Ultraviolet Light exposure from the sun or through artificial UV Rays like tanning beds causes majorly cancer of the lips.
- Epstein-Barr Virus infection causing infectious mononucleosis increases the risk of cancers.
- Radiation Exposure.
- Family history of cancer.
How Is Oral Cancer Diagnosed?
It can be discovered as an ulcer, growth, or a lump during your routine dental examination or confounded by yourself on self- examination.
It is recommended for everyone to frequently self-examine their oral cavity in a mirror with bright light once a year and once in 3 months if the person is a smoker or tobacco chewer. One should look for any alteration in the surface and texture of the lining of all the areas of the mouth. For everyone in the general population, it is recommended to have a dental examination by a dentist for any swelling, ulcer, or lesion inside of the mouth once a year. The American Cancer Society recommends oral cancer screening exams every 3 years for persons over age 20 and annually for those over age 40.
What to do if you suspect something?
If any suspicious lesion is found, it should be biopsied by the surgeon to diagnose oral cancer. If the biopsy is positive, then other investigations are advised-
- CECT scan of the face and neck to see the extent and the spread of the cancer
- FNAC (needle cytology) of neck lymph node if it is enlarged.
If the biopsy is negative but the lesion is still suspicious, a repeat biopsy from the deeper areas is recommended.
What is the Life expectancy after developing Oral Cancer?
It is difficult to predict life expectancy in exact figures in people with oral cancers. It develops on a lot of variables like the stage of the disease, location of cancer, and spread of cancer to various parts of the face and body.
The life expectancy is estimated and told in terms of the 5-year survival rate of the suffering patients.
The overall 5-year survival rate for patients with an early diagnosis of oral cancers with no spread to other parts of the face and body is more than 85- 90 %.
If cancer has spread to nearby tissues or lymph nodes, the 5-year survival rate drops to 70%
If cancer has spread to the body, the 5-year survival rate is less than 40%.
How can you prevent oral cancer?
Yes. Up to some extent, oral cancer can be prevented by
- Following a healthy lifestyle
- Eating a balanced diet with more vegetables and fruits
- Avoid tobacco in any form (STRICTLY SAY NO TO TOBACCO)
- Avoid overindulgence in alcohol
- Use of sunscreens over the face to mitigate the effect of UV rays over the lip region
- Avoid multiple sexual partners
What is the treatment of oral cancer?
Oral cancer is treated in the same manner many other cancers are treated. Surgery is done to remove the cancerous growth along with the reconstruction of the mouth and face, followed by radiation therapy and/or chemotherapy (drug treatments) to destroy any remaining cancer cells.
How can you prepare for Oral cancer Surgery?
- CT Scans & X-Rays taken for assessment of the extension of cancer.
- A biopsy is recommended before proceeding with the definitive surgery
- Pre-operative photographs will be taken which will be used during the process of reconstruction.
- CT Angiogram of the limb can be done to evaluate the blood vessels of the donor site.
- Arrange one to two units of blood
- Admit a day before the surgery.
- Highlight the importance of tracheostomy (a hole made in the windpipe to bypass the oral cavity), the need for ICU care, and post-operative ventilation after the surgery.
- Consent will be taken for microvascular surgical exploration if vessels get blocked after the surgery.
Dr Amit Agarwals focus during consultation
- Location, Size, extent & prognosis of oral cancer requiring resection.
- The size of the defect created after the removal of cancer should be noted. Areas of the resected tongue, mucosa, lips, lower jaw (mandibular), or upper jaw (maxilla) should be outlined and kept in mind.
- Presence of remaining teeth.
- Available mouth opening.
- Functional limitation of the tongue.
- Amount of remaining soft tissue.
- Age & general health of the patient
Surgical procedure includes
Initially, general anesthesia is administered by a very competent anesthetized and intensivist. Tracheostomy is done if required. A Ryles's nasogastric tube is inserted through the nose and a urinary catheter is placed for draining urine and monitoring.
Then, modified radical neck dissection is done by the cancer surgeon to remove the possible diseased lymph nodes from the neck and wide local excision of the tumor beyond its indurated and hard margin is done along with the removal of the involved upper jaw and/or lower jaw if required.
Oral Cancers involve critical structures associated with major functions. Excision of part or all of these structures causes disfigurement and misfunctioning of the structures. Reconstruction may include bone, muscle, and/or skin transfer along with the associated blood vessels to rebuild areas damaged by cancer and cancer treatment. The goal of reconstruction after head and neck surgery is to return the appearance and function to its original form as much as possible. This is accomplished through a variety of techniques.
Microvascular Reconstruction for oral cancer
Microvascular reconstruction is an advanced surgery in which a highly powerful microscope is used to re-establish connections in the blood vessels and nerves for tissues that are transferred from one part of the body to the other.
The harvested tissue is used to reconstruct the area with the surgical defect. It helps to heal the defect and helps restore form and function.
How can you prepare for Oral cancer Surgery?
*depend on the constituents of the created defect*
If only mucosa and soft tissues are resected and removed
Then Skin Flap Transfer composed of skin, fascia, and fat is harvested from the forearm or thigh to reconstruct the tongue, floor of the mouth, cheek, lip skin, and pharynx. Radial artery forearm free flap, Anterolateral thigh flap, and Medial sural artery perforator free flap are very commonly used flaps used by Dr. Amit Agarwal.
Radial Artery Forearm free flap
Skin and soft tissues from the forearm region are harvested with their artery and vein. The flap is then transferred to the head and neck region. The flap is reshaped and is inset with the remaining mucosa and soft tissues present, and the vessels are anastomosed at the recipient site with the appropriate artery and vein. The donor site is covered with the help of a skin graft taken from the thigh. Dr.. Amit Agarwal does not prefer this flap now as it leaves a bad scar over the forearm.
Anterolateral free flap
Skin and soft tissues from the outer aspect of the thigh are harvested with their artery and vein. The flap is then reshaped & inset in the created defect. The donor site is primarily closed with sutures. This is the flap of choice by Dr. Amit Agarwal for even large oral cavity reconstructions as the donor site is well hidden under the clothes.
Medial sural artery free flap
Skin and soft tissues from the inner aspect of the calf are harvested with their artery and vein. The flap is then transferred to the head and neck region and inset in the defect. The donor site is primarily closed with sutures. Dr. Amit Agarwal prefers this 'new age flap' now for small oral cancer reconstructions as it gives the best cosmetic result in both the face and leg region.
If the lower jawbone is also removed along with mucosa and soft tissues
Then Free Bone+Skin flap Transfer, harvested from the leg is used when part of the lower jaw is removed along with cancer. This flap restores the external appearance of the face, and it restores chewing, swallowing, and speech functions.
Free fibula flap
Free fibula flap- The fibula Bone which is the smaller one of the two bones present in the leg, is harvested with its artery, vein, and skin. The flap is then transferred to the head and neck region. The bone is reshaped and is fixed with the remaining jaw bone with plates, skin and soft tissues taken with the bone are inset in the defect created after the excision, and the vessels are anastomosed at the recipient site with appropriate artery and vein.
The donor site is covered with the help of a skin graft taken from the thigh. Removing part of the fibula bone from the leg does not create any problem in walking or movements of the leg and foot. For dental rehabilitation, dental implants are placed one year after the surgery.
Post Surgery
Post-Operative Recovery after Oral cancer reconstruction
- The patient should be kept in ICU for a minimum of one to 2 days. There could be a possibility that the patient is kept on a ventilator for one day.
- The flap is monitored frequently post-surgery. Hospital stay is increased with microvascular reconstruction, but it is the best modality to cover the defects in the mouth after cancer removal.
- The patient is kept on antibiotics, IV Fluids, and analgesics for pain.
- Head end elevation is to be maintained for the next 3 weeks. Ryle's tube feeding will be given through the nose to bypass the mouth for healing of the sutures in the mouth.
How much time does it take to Recover?
- Betadine mouth gargles are advised 3-4 times a day every day till healing is complete.
- The dressing is done every alternate day.
- Drains from the neck are removed after 4-5 days of surgery but can be kept for a long. The urinary catheter is removed 3-4 days after surgery.
- The patient is admitted for at least 7-8 days and discharged once the flap is settled.
- Sutures are removed after 2 weeks.
- Oral feeds are started after 10-14 days of surgery and then Ryle's nasogastric tube is removed.
- Mouth opening exercises are started after 3 weeks of surgery
- Complete recovery time is of about 3 weeks.
Why kayakriti?
- The success rate of microvascular reconstruction is quite good around 95% in hands of Dr. Amit Agarwal. It means 95 out of 100 mouths are successfully reconstructed after the removal of cancer. The results of microsurgical reconstruction can be quite unpredictable as dependent on multiple factors like the status of blood vessels, level of immunity of the patient and his/ her health status, and protein level to withstand the procedure.
- Microsurgical techniques are helpful if done at the appropriate time and it also depends on the type and size of the cancer. Post- surgical management is equally important for the overall outcome of the treatment.
- After the surgery, the patient is bedridden for 2-3 weeks. No ambulation is advised, and the limb from where the flap is taken has to be elevated by using pillows underneath. After several dressings, when the operated site is completely stable, the patient is given pressure garments and ambulation is started.
- Further treatment in form of radiotherapy and/or chemotherapy depends on the final histopathology report. Radiotherapy should be started within 6-8 weeks of surgery and all the wounds over the face should be completely healed before going for radiotherapy.
Post-operative Complications of Oral cancer excision and reconstruction
- Risks related to anesthesia. General Anaesthesia is very safe in present times and with the best machines and a qualified anesthetist, the chances of encountering any complication are less than 0.1 percent in a healthy individual.
- Risks related to Microsurgical reconstruction of flap technique like thrombosis or blood clot in the vessels of the flap, re- exploration / re-surgery to remove these clots, and flap failure is seen in less than 5 percent of cases.
- Few patients develop some degree of skin slough or partial flap necrosis. This was more often the case in smokers, in people with multiple diseases, and also in patients having undergone anastomotic revision.
- Oro-cutaneous fistula – there is a possibility of developing communication between the cavity of the mouth and the external skin through the sutures of the neck. The chances increase with advancing age, bad nutritional status, and disease of the patient. This can lead to catastrophic consequences if not treated in time. This might require revision surgery in terms of fistula closure.
- Rare chances of infection which response to prolonged antibiotic therapy.
- Bleeding or hematoma formation can occur which might require drainage.
- Poor wound healing because of poor blood supply of skin flaps. Seen more commonly in smokers, diabetes, hypothyroidism, and individuals with multiple comorbidities. Poor wound healing can lead to skin discoloration which can cause marginal or total skin necrosis
- Scars will be there along the incision line which will fade with time. Scars can get hypertrophied if you are prone to it.
- Rare events of Deep vein thrombosis and pulmonary or cardiac complications can occur or precipitate in patients with multiple pre-existing diseases diagnosed or undiagnosed by routinely available standard tests.
- Possibility of revision surgery in cases of flap failure or graft loss.
- Facial Asymmetry
- Sutural dehiscence of the skin flaps
Shaping dreams through
Know your surgeon better
Best plastic surgeon, Dr. Amit Agarwal is an American Board Certified, extensively trained, and best Plastic & Aesthetic surgeon in Lucknow. He is the Chief Plastic Surgeon heading the Department of Plastic, Microvascular, and Craniofacial surgery at Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, U.P, India. He maintains a busy practice at Avadh and Nishat Hospital and his own center - Kayakriti Plastic Surgery & Dental Center. He was formerly a Consultant in the Department of Plastic Surgery and Burns at the prestigious SGPGI, Lucknow.
MS, DNB (General Surgery) MCh, DNB (Plastic Surgery),
MNAMS, FACS, FICS, FRCS (Edinburgh, UK)
His Credentials
Three pillars of kayakriti
Privacy
We believe your experience with us should be comfortable and hassle-free to make it one of your best lifetime experiences for yours. We, here at the clinic, take full precautions to maintain your privacy in any manner. We also provide a staff who will receive you from the gate and take you to the chamber directly if you demand.
Trust
Our Surgeon is highly qualified and internationally certified with a team of skilled staff to perform any surgical or non-surgical treatment on your body.
Safety
When you plan to undergo any surgery you should always keep in mind that it's your body and it's a surgery. We, here always keep your safety a priority and will never recommend you to undergo any such procedure which is not safe for you. We also provide you with a detailed description of the complications which may occur after the surgery during the consultation as it's a surgical procedure so there may be some complications depending on the way your body reacts.
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Frequently Asked Questions
If you have flat or small breast and you want to improve your breast and hip contour ratio then you are a good candidate for it. The answer will be best provided after the first consultation with Dr Amit Agarwal.
Acute pain will be there for almost a week which gradually reduces and there will be soreness and swelling which may take up to 3 weeks to subside.
You can join your work and daily routines after a week of the procedure and can start exercising after 3 weeks of it.
Yes, you have to wear it round the clock unless we suggest you to remove it.
This surgery does not affect the ducts or the areas of the breast involved in milk production. Thus, it does not affect the breast feeding.
This surgery does not affect the ducts or the areas of the breast involved in milk production. Thus, it does not affect the breast feeding.
Kayakriti Plastic Surgery & Dental Center
D-43, Near Punjab National Bank, Rajajipuram, Lucknow, Uttar Pradesh - 226017, India
Phone No. +919695940009, +919695940006
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